1. Introduction
In Victoria, the healthcare system for children is overburdened by increasing general practitioner (GP) referrals to hospital emergency departments (EDs) and outpatient clinics. GPs could be supported to manage children closer to home.

2. Practice change implemented
We co-designed and implemented a GP-paediatrician integrated care model comprising: weekly paediatrician-GP co-consultation sessions at the GP practice; monthly case discussions; and phone and email support for GPs.

3. Aim and theory of change
The model was designed to support GPs to deliver higher quality of care, with greater confidence for a broader range of childhood health concerns. We measured: model feasibility and acceptability; GP confidence, referrals and care quality; family experience and preference for care; and costs.

4. Targeted population and stakeholders
Population: 49 participating GPs from 5 GP practices (2 metropolitan and 3 regional); and their patients aged 0 – 17 years, and families; and 2 Paediatricians.
Stakeholders: The Royal Children’s Hospital; Sunshine and Werribee Mercy Hospitals; North Western Melbourne Primary Health Network (PHN); and the Victorian Department of Health and Human Services.

5. Timeline
12-month intervention.

6. Highlights (innovation, Impact and outcomes)
The model was feasible and acceptable to GPs, families and paediatricians with 624 children seen in the co-consultations and 50 case discussions conducted. In pre-post testing, there was a 7% absolute reduction in ED referrals, 20% reduction in GP low value care; increased GP confidence in paediatric care (88% to 100%); and family confidence in GP care (78% to 94%). Families reported ease and comfort of receiving paediatric care closer to home. Model costs as implemented were $172 over and above usual care, per child seen in the co-consults. However, in an idealised implementation scenario, the model has the potential to be cost saving for families, state/federal governments and hospitals.

7. Comments on sustainability
Sustainability planning was completed in partnership with the PHN and the practices; two have hired paediatricians, with others exploring options for access to paediatric support and learning (e.g. webinar program). The research team plan to complete a larger, multi-site multi-state trial to rigorously evaluate effectiveness and cost-effectiveness of the model in high referral areas.

8. Comments on transferability
This integrated care model could be replicated for chronic complex care that burdens the hospital system, or implemented in service hubs with co-located paediatricians, or extended to include telehealth for rural/regional hubs.

9. Conclusions (key findings)
Developing and embedding a GP-paediatrician integrated model of care in Australia’s primary health care system is feasible and acceptable; improves GP confidence and quality of paediatric care; benefits families and children; and may reduce referrals to hospital services.

10. Discussions
Truly integrated care, delivered as a collaboration between hospitals, health networks, GPs and their practices has the potential to shape a health system in which children can receive higher quality, timelier care, closer to home.

11. Lessons learned
Co-design and initial onsite-support were crucial e.g. billing; data collection; co-consult structure and purpose. The drive and desire to provide better care for children is the strongest motivator for change.

Introduction: Asthma is the most common chronic illness of childhood. Frequent asthma attacks may result in unscheduled hospital presentations. Unscheduled hospital presentations are a marker of poorly controlled asthma - a significant burden to the health systems and families. Following hospital presentation, the New South Wales (NSW) clinical practice guideline suggests follow-up with the general practitioner (GPs) within 3-5 days. However many children only have their asthma reviewed in hospitals when there is an acute attack rather than having a planned GP review.
Implementation of practice change: The Sydney Children’s Hospitals Network (SCHN) Asthma Follow Up Integrated Care Initiative assembled a multidisciplinary team of clinicians, nurses, GPs, managers, researchers, and consumer representatives. The team created a driver diagram to identify change ideas and developed an integrated model of care to improve post-discharge follow-up of children with non-complex asthma
Aim: To reduce emergency department (ED) presentations, through improved asthma management and increased engagement with their GPs.
Targeted population and stakeholders: Children aged 2-16 years of age with non-complex asthma or viral induced wheeze (VIW), local health partners and parents/carers.
Timeline: December 2016-February 2018
Innovation: The integrated model of care included the following:
1) All children, presenting to ED with non-complex asthma/VIW, for ≥4 times in a 12 month period were flagged in electronic medical record system .Care coordinators (CCs) contacted the parents and requested that their child have a review with their GP, and also offered referral to asthma education sessions.
2) A letter was sent to the child’s GP by the CC advising of the child’s recent hospital presentation. This letter contained asthma best practice points, encouraged influenza vaccination, review of asthma action plan, preventer medication and referral to a paediatrician if necessary.
3) Parents were also given a standardised asthma/ VIW resource pack upon discharge from ED which included individualized Asthma Action Plan, asthma information pack and discharge instructions (including recommended follow-up with a GP).
Impact: We compared the number of asthma ED presentations for these children six months pre and post enrolment using Wilcoxon signed-rank test.
Outcomes: A total of 57 children were contacted by CCs. The median age of the children was 4 years (IQR 3-5 years). The median numbers of ED presentations in the six months preceding enrolment in the program was 2 (IQR 2-3) and post enrolment was 1 (IQR 0-1). There was a 57% reduction in number of children who presented to the ED ≥4 times in the 12 months period post implementation of the program (z=3.25, p =0.001).
Sustainability: The initiative has been adopted as routine clinical practice within SCHN.
Transferability: Although the model was evaluated within the SCHN , based on the positive preliminary findings the model can be scaled up across all local health districts of NSW.
Conclusion: A comprehensive integrated approach to asthma management may reduce frequent ED presentations due to asthma in children.
Lessons learned: It is important to have a collaborative multidisciplinary team, in order to share expertise, understand all view points and effectively implement change.

Introduction: FBT-AN is the internationally recognised evidenced-based first-line treatment for adolescents diagnosed with anorexia nervosa. Access to FBT-AN trained clinicians for families living outside major metropolitan areas is limited particularly in large geographically diverse states e.g. Queensland Australia. A National Eating Disorder Collaboration and Butterfly Foundation report investigating social and economic impact of eating disorders clearly outlined families’ frustration in response to poor access to evidenced-based treatments across Australia.
Description: To address this inequity of access to evidenced-based treatment options, the Children's Health Queensland, Child and Youth Mental Health Service, Eating Disorder Program invested in 2-year pilot project offering FBT-AN to families across Queensland using the medium videoconferencing.
Aim and Theory of Change:Systemic interventions are known to be important in facilitating change in adolescent mental health. Effective modes of delivering systemic interventions need exploration. This pilot study aimed to investigate the efficiency and effectiveness of FBT-AN using video-conferencing as the medium of service delivery. It was hoped that if FBT-AN could be delivered effectively using video-conferencing, the availability of evidenced based treatments could increase to non-metropolitan areas where specialist services or trained clinicians are unavailable.
Targeted Population: Families living in regional, rural or remote Queensland, with a child or adolescent diagnosed with Anorexia Nervosa, who met criteria for FBT-AN, and were engaged with their local Child and Youth Mental Health Service (CYMHS), were offered the opportunity to participate in the pilot. A total of 28 families participated including 5 families seen face-to-face for comparison purposes.
Timeline: The pilot ran for 2 years and concluded in 2019
Highlights: A total of 7 Queensland Hospital and Health Services participated in the pilot, each making multiple referrals over the 2 year period and advocating for continuation of the service beyond the pilot.
Sustainability and Transferability: The outcomes and learnings of the pilot were used to inform a Governance Framework embedding telehealth services including the medium of video-conferencing as core business of the CYMHS Eating Disorder Program. This Framework is being used to inform similar Frameworks across CYMHS specialist teams in the CHQ context. Core aspects of the Framework will be identified
Conclusion: Families participating in the pilot provided positive feedback about the experience, emphasising the importance of access to recognised expertise and evidenced based treatment for their child. Local CYMHS reported increased confidence in the identification and treatment of eating disorders as an outcome of the pilot. Early data analysis indicates that FBT-AN can be provided with efficacy and effectively with positive outcomes for families via videoconferencing.
Discussion: While videoconferencing is widely used in assessment and consultation in health services, it is not widely used in the provision of therapeutic treatments. This pilot has demonstrated videoconferencing as a practical medium for treatment. Its utility for families outside major metropolitan areas is undoubtable
Lessons Learned: Videoconferencing as a medium for providing therapeutic interventions is fraught with challenges. Significant learnings occurred with regard to treatment set-up, maintaining engagement of families and services, technology requirements, and clinical governance issues. These will be noted in this presentation

Introduction: The number of children with medical complexity (CMC) residing in regional/rural Australia is growing, challenging the health system to provide equitable care. Families of CMC experience problems in accessing appropriate care locally, and high out-of-pocket costs and family disruptions because of long travel distances to access care in metropolitan paediatric hospitals. The Murrumbidgee Local Health District (MLHD) in collaboration with the Sydney Children’s Hospitals Network (SCHN) partnered with families and local services to co-design a Model of Care (MoC) to better meet the needs of CMC, their families and local services.

Theory/Methods: The MoC was co-designed with families, local healthcare providers and the SCHN. To qualify for enrolment in the new MoC children had a diagnosed condition involving more than one organ system, were medically fragile or reliant on medical technology, or had used health services frequently in the last 12 months e.g. >6 emergency department presentations, long hospital stays, 4 or more admissions and >10 outpatient clinic visits. To demonstrate changes in parent-reported experiences, we used the Paediatric Integrated Care Survey (PICS) in a longitudinal cohort design at baseline, and 6 months after enrollment.

Results: 41 CMC have been enrolled and 18 had both the baseline and 6-month follow-up PICS assessment. A preliminary analysis has been conducted on these results. Difficulties navigating healthcare systems, fragmented care, poor communication, and limited care planning and goal setting were apparent at baseline. After accessing the MoC for at least 6 months (6-14 months) there was a 33% increase in written short term care goals (p=0.045). Care teams were 11% more likely to discuss healthcare decisions that impact the whole family (p=0.005) and intra-team communication improved for 5.5% of families (p=0.003). Interestingly, 22% of families were less comfortable letting team members know about concerns about their child’s healthcare (p=0.001).

Conclusions and lessons learned: Utilising a validated tool such as the PICS periodically during implementation of the new MoC provides feedback loops to inform future model adjustments. The PICS has highlighted the need for shared care plans and recognition of the impacts of caring for a CMC on family functioning. Ongoing engaging with families provides a wealth of unique knowledge, with their inclusion in service design and evaluation crucial to successful integration of care.

Limitations: This study is limited by its size and resourcing which limited the design to a longitudinal cohort study pre and post intervention. Although the PICS is a validated tool, there is limited published utilisation of the survey in the Australian context.
Suggestions for future research: Ideally a step-wedge randomised controlled trial of a new MoC implemented across several sites with primary outcome measures for the family, for healthcare providers and for the healthcare system. Qualitative research is needed to better understand the longitudinal PICS data.

1. Introduction
Health professionals conducting medical procedures with children, face challenges in avoiding a physical struggle, minimising pain, and preventing distress for both child and parent. These challenges are particularly evident in Burns Units. Studies suggest that ~50% of children with burn injuries display some post-traumatic symptoms [1]. Younger children are also particularly susceptible to high distress and anticipatory fear, which may contribute further to pain. Several studies indicate that distraction techniques can reduce children’s pain and distress during these wound care procedures [2,3].

2. Short description of practice change implemented
Starlight is a non-profit organisation, committed to supporting integrated care through the hospital and community programs it delivers to improve the lives of seriously ill children and young people.
Identifying the impact of painful procedures, Starlight piloted the ‘Captains on Call’ initiative in the Day Surgery Burns Unit of Adelaide’s Women’s and Children’s Hospital. It involves Starlight Captains (highly skilled professional performers) using fun, play and distraction techniques to reduce child and parent stress and anxiety, working with the medical team to meet the unique needs of each patient.

3. Aim and theory of change
Ultimately, the aim of ‘Captains on Call’ is to reduce the distress and pain experienced, through integrating Captain Starlight with the clinical team. This reduces anticipatory fear for follow-up visits, improves the attitudes towards health professionals, and creates a positive, anxiety-free hospital experience. For the Burns Unit specifically, this may ultimately help reduce the currently high prevalence of post-traumatic symptoms occurring.

4. Targeted population and stakeholders
The target population for this initiative is children requiring medical procedures. Key stakeholders include family members, Health professionals, the broader hospital community and Starlight.

5. Timeline
The pilot commenced in 2018, with evaluation findings available by October 2019.

6. Highlights (innovation, Impact and outcomes)
‘Captains on Call’ is the first documented initiative in Australia providing positive distraction to paediatric patients undergoing potentially distressing and painful medical procedures. This care integration has the potential to improve psychosocial outcomes, reduce pain and minimise the potentially traumatic nature of the procedure.

7. Comments on sustainability
Embedded within every children’s hospital, Starlight is a well-established organisation,
in the advantageous position to extend ‘Captains on Call’ nationally. There is no cost incurred to the health system and appears to be minimal burden on clinic staff.

8. Comments on transferability
The model is applicable to other medical procedures for children. Starlight are currently in discussions to expand this initiative to other clinics, such as Fractures and Oncology.

9. Conclusions
Early data indicates the program impacts positively, creating a notable difference to children’s experience. Parents and clinicians report a reduction in anxiety and improved overall medical experience. All children and parents want ‘Captains on Call’ available for return visits.

10. Discussions
Program evaluation data will be discussed, highlighting successes and challenges.

11. Lessons learned
Starlight reviewed the pilot process of integrating the initiative within paediatric units, leading to specific training and outlining parameters to ensure successful implementation.